A 54-year-old man presented to the Emergency Department for left lower extremity pain and swelling. The patient's medical history included peripheral vascular disease with a chronic non-healing venous stasis ulcer of the left lower extremity, as well as mechanical aortic valve replacement with ongoing warfarin anticoagulation. While being examined, the patient had a spontaneous episode of epistaxis. Laboratory testing revealed an International Normalized Ratio (INR) of greater than 8.18 (normal 0.85-1.15) and a prothrombin time of greater than 100 seconds (normal 9.4-13.0 sec). The patient's supratherapeutic INR was treated with 10 mg intravenous (IV) phytonadione (vitamin K) (AquaMEPHYTON) in 50 mL sodium chloride 0.9%. A type and screen was sent to the blood bank laboratory in anticipation of plasma transfusion. Following centrifugation, a bright yellow discoloration of the plasma was noted (Fig. 1). Further investigation revealed that the type and screen was drawn concurrently Fig. 1. Patient type and screen specimen, plasma.Fig. 2. Phytonadione (vitamin K) (AquaMEPHYTON).

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